Fasciola Opisthorchis Opsthorchis Dicrocelium

LIVER FLUKE Fasciola hepatica Clonorchis sinensis

gigantica felineus viverrini dendriticum
Sheep liver fluke Chinese liver fluke Fasciola lanceolata
COMMON NAME Giant liver fluke Cat liver fluke Asia liver fluke
Common liver fluke Oriental liver fluke Lancet fluke

Sheep liver rot or

DISEASE Fascioliasis Clonorchiasis Opisthorchiasis Dicroceliasis
Fascioliasis hepatica

Europe, Asia, Northern

Asia (japan, india,
Africa (genuine human
Worldwide, prevalent in turkry, korea) Thailand
Far East (Japan, Korea, cases were diagnosed),
GEOGRAPHICAL sheep raising countries Europe (spain, Italy, Laos
Africa & Asia China, North Australia, N. & S.
DISTRIBUTION (US, Argentina, Puerto Greece, fance, Vietnam
Vietnam,Taiwan, HK) America (less common),
Rico) Germany, Cambodia
USSR (numerous cases
switzerland, holland
of human infection.

Dog
Sheep
Cat
Sheep Dog Deer
Herbivorous animals Fox
Goats Cat Cattle
RESERVOIR particularly cattle & Pig
Cattles Pig Goats
HOSTS carabao (buffalo) Man
Carabaos (in Phil.), Rat Pig
occasionally man Rabbit
occasionally Man Man Rabbit
Seal
Man
Lion

Biliary passages of the liver Biliary tract of the Biliary passages of the
HABITAT Biliary tract of the liver
of herbivorous animals liver liver

ADULT WORM

Large Spatulate Lancet shape Lancet shape

Larger & more Esophagus is
Characteristics Leaf shaped fluke Transparent Thin & transparent Flat & transparent
lanceolate elongated
Brown to pale gray flat Reddish yellow Integument is aspinose

Size 30mm x 13mm, 30-70 x 3-11mm 10-25 x 3-5mm 7-12 x 2-3mm 5-15 x 1.5-2.5mm

Bears a conical projection

Anterior End Shorter cephalic cone Attenuated or pointed Attenuated
called a cephalic cone

Posterior End Rounded rounded Rounded

Oral sucker larger than Oral & ventral sucker

Sucker 2, (oral & ventral) Larger ventral sucker 2, (oral & ventral)
ventral sucker nearly equal in diam.

More branched esp.

2, bear a no. of lateral Blind, simple and extend Blind & simple; not
Intestinal ceca toward midline of
branches to the posterior end branched
body

2, large, deeply lobulated

& branched w/c lie at the
Testis 2 More ant. position
post. end of body, lie one
behind the other
Small, w/ 3 lobes & is
Ovary Branched
anterior to the 2 testis
2, not branched; 2, slighty lobed and
lobed & obliquely Ovary & testis nearer obliquely placed,
placed to each other to each other and noth anterior to the ovary
are deeply lobulated
(compared to O.
Not branched; small Lies in front of the
felineus)
and lobed w/c is ant. midline, posterior to the
to the 2 testis 2 testis

Consists of granular
aggregates in the lateral
Vitellaria Branched
fields at the middle 3rd of
body
Consists of numerous,
Aggregated into At the lateral fields, in
transversely
clusters the middle of the body
compressed follicles

O O O T
Genital formula T T T T
T T T O

5 years in Sheep
Life span 15-20 years
9-13 years in Man

EGG

Small
Operculated Thick shelled
Operculated
Large Ovoid/Flask shape Operculated
Ovoid
Operculated -shape resembles an Deep golden yellow
Yellowish brown
Characteristics Ovoid in shape larger electric bulb
With minute
Brownish yellow color Yellowish brown Resistant to dessication
tubercular thickening
Develop only in water Possess a terminal hook but do not hatch in
at post. end
like spine at the posterior water
end

Size 140um x 80um 160-140 x 70-90um 26-30 x 15-17um 30 x 11um 35-45 x 22-30um

Contains fully
When passed out in Non embryonated or Contains a ciliated
developed Fully embryonated
feces immature embryo
miracidium
 In saturated sol’n of
Does not float
common salt
LIFE CYCLE
Definitive Hosts Sheep, goat, cattle, man
Intermediate Hosts
1st IH: snail
(Lumnaea philippinensis,
Lymnaea swinhoe)
2nd IH: aquatic plants
water cress (Nasturtium
officinale)
Kangkong (Ipomea
Obscura)
Pathogenicity Symptom of fascioliasis
include the ff:
1. Acute or Invasive Phase
– corresponds to the period
during w/c the parasite
migrated from the intestine
to the liver
a. biliary colic with N/V,
anorexia & headache
b. persistent diarrhea,
irregular fever, anemia
c. tender hepatomegaly
with eosinophilia,
leukocytosis & urticarial
2. Latent or Chronic
Phase – corresponds to the
period when the parasite
has settled in the bile duct
a. Obstructive jaundice –
presence of adult worm
interfere with the flow of
bile
b. Atrophy of the liver
(cirrhosis)
c. Cholelithiasis – presence
of stone in the gall bladder
Halzuon or Pharyngeal
Fascioliasis
- ingestion of raw sheep or
goat liver common in
Lebanon and Armenia;
lodgement of adult worm
on the pharyngeal mucosa
causing edematous
congestion of the soft
palate, pharynx, larynx,
nasal fossae & Eustachian
tube accompanied by
dyspnea, deafness &
asphyxia
Diagnosis 1. Findings of eggs in stool
or bile
2. Immunodiagnosis –
immunoelectrophoresis,
compliment fixation test,
ELISA, Western blot;
detect the presence in
serum
Treatment Emetine Hydrochloride
- given IM
Bithionol – DOC
Hexachloroparaxylene
Praziquantel
Chloroquine
Tribendazole
Does not float
RH RH RH
1st IH: snail (Buliminae)
1st IH: snail
Parafossarulus 1st IH: Land snail
(Bithynia or
manchouricus (most (Zebrina detrita,
Bulimus leachi)
common) Helicalla candidula)
2nd IH: fresh water
2nd IH: fresh water fish – 2nd IH: Ant
fish (Cyprinidae)
cyprinoid fish (Formica fusca)
- carp
(family Cyprinidae)
-Main pathological Infection is acquired Higher incidence of Symptomatology:
changes are confined to thro’ consumption of diarrhea, flatulence 1. Chronic constipation
the walls of the duct infected raw fish and pain over the 2. Flatulent dyspepsia
become thickened 1. Painful liver; jaundice is also 3. Hepatomegaly
resulting to periductal enlargement of the present 4. Systemic toxemia
fibrosis liver & passive 5. Diarrhea & vomiting
congestion of the Prevalence:
-Symptoms: chronic spleen North Thailand
diarrhea, 2. Jaundice –high(endemic)
fullness of the abdomen, 3. Cholecystitis 70% in areas like
weight loss, fever, tender (infection of the gall KhonKaen province,
hepatomegaly, recurrent bladder) with colic – in Chi river
attacks of jaundice due to bile stones 

formed Central Thailand –low
-Complications: 4. Abdominal Southern Thailand
cholangitis – infxn of the disturbances -none
bile ducts 5. edema of the face
Intrahepatic calculi & extremities and Infxn w/ O.viverrini
formation & gallstones ascites – due to predisposes to
Cholangicarcinomma encroachment of the cholangiocarcinoma
(cancer of the gall scar tissue on liver (CA of the bile ducts);
bladder) cells and portal 90% of cases in
vessels KhonKaen region in
Thailand between ages
Complication: 25-44 yrs. Old
Carcinoma bile ducts,
liver & pancreas with Thai dishes of raw
metastasis to fish: koi-pla (raw fish
epigastric lymph in spicy salad)
nodes. Pla-ra, pla-sam,
som-pak (salted fish)
1. demonstration of eggs Recovery of eggs in Recovery of eggs in
by microscopic stool or by duodenal feces and duodenal
examination of feces & intubation drainage
bile
2. Blood exam –
leukocytosis, eosinophilia
3. Immuno diagnosis –
complement fixation test,
indirect hemagglutination
test
Intradermal test –
immediate
hypersensitivity reaction
4. Liver scan
Antimony compounds – Praziquantel Thymol
sodium antimony tartrate, (Biltricide) – safe Stibophen
tartar emetic, fouadin and effective drug Praziquantel – dose:
Clhoroquine Bithionol 25mg/kg 3x a day fo 1
Praziquantel – DOC day
Albendazole, Dichlorophen
mebendazole, Albendazole – dose:
triclabendazole 7-9 mg/lb single dose
Prevention 1. Eradication of the 1. prevent pollution of Avoid eating raw or Fresh herbs collected
disease in animals water with feces of the inadequately cooked from grazing areas for
2. Destruction of the snails reservoir host fish use as food for humans
by use of molluscides 2. eradication of snail should be washed
(1-50,000 sol’n of copper hosts thoroughly to remove
sulfate) 3. avoid eating raw fish & the ants.
3. thorough cooking of veg. thorough cooking of fish
or washing it with 5%
vinegar or KMNO4 for
5-10min.
4. Boil drinking water in
areas where infxn is
endemic